If you’re not in the mood for some dense think-tank talk about  ICD-10 today, read on.  For a change,  let’s look at the risks of continued ICD-10 delay using the metaphor of a favorite children’s hand game. (Your hospital has delayed, right? Most hospitals have.)

In the old hand game, the “rock” beats scissors, the “scissors” beat paper and the “paper” beats rock. If both the players throw the same shape, the game is tied. In my slightly over-the-top metaphor, let’s play the game this way:

The Rock: The rock in ICD-10 is the work. Everything your organization must do to achieve the conversion.

• the impact assessment
• the plan
• the organizational awareness program
• the hammering away at the vendors and payors
• the future coding strategy
• the staffing
• the systems changes
• the documentation changes
• the training
• the external and internal testing
• and so on

It’s a ton of collaborative, time-consuming work that must be taken on by members of almost every hospital department.

The rock presents its unique risks. If there is no strong leadership pushing it in the right direction —  if the assessments, planning, execution, testing and training — are inadequate or badly managed, the rock will be crushed by the official changeover to ICD-10 in October, 2014. On the other hand, if the rock is as strong as it should be, it will beat…

The Scissors: The scissors represent the loss of money. This starts with CMS, who promises to cut off your Medicare and Medicaid payments if you’re not transacting with ICD-10 codes by the 2014 deadline. (So will many, if not all, payors.) Just as significant, other money risks include:

• costs of implementation
• retraining and/or adding to coding staff (or some other solution)
• potential short-term slow-downs in coding and reimbursements
• initial coding errors that cause increased denials
• documentation that is not up to ICD-10 snuff.

CMS, AHIMA and others predict that ICD-10 will initially result in a major decrease in cash flow and loss of revenue for many organizations.  Denial rates are expected to increase dramatically — as much as 200% — with a corresponding increase in accounts receivable delays.

The scissors — these pesky financial issues —  must be planned for, but the damage can be minimized by….

The Data: Clean, clear, correct and complete ICD-10 coded documentation and transactions, moving efficiently throughout the healthcare process. Correctly upgraded and tested systems and processes that manage and transmit data, using ICD-10 will be a powerful match against the risks to revenue. Improved documentation that has been created by well-trained staff will support that data.

Good data will protect against many of the financial risks.

Again, though, the risk to the data goes right back to the rock — the work.  Your organization’s work needs to start now, if it already hasn’t.  If you have started, take the time to do it right. If you don’t know how, get help!

In this ICD-10 game, there will be no tie.

Need help getting started? Begin your transition with a Free One Day ICD-10 Assessment.